Provider Demographics
NPI:1225086366
Name:LABANOWSKI, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:LABANOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 W MAIN ST
Mailing Address - Street 2:STE. 2
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1224
Mailing Address - Country:US
Mailing Address - Phone:334-673-2501
Mailing Address - Fax:334-673-2502
Practice Address - Street 1:2346 W MAIN ST
Practice Address - Street 2:STE. 2
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1224
Practice Address - Country:US
Practice Address - Phone:334-673-2501
Practice Address - Fax:334-673-2502
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000155082084N0400X, 2084N0600X
GA0577592084N0400X, 2084N0600X
FLME716982084N0400X, 2084N0600X
GA577592084S0012X
AL155082084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Not Answered2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32296OtherBC/BS OF FLA
AL515-30726OtherBC/BS - EUFAULA LOC.
AL515-21455OtherBC/BS
AL515-27163OtherBC/BS - OZARK LOC
AL515-27354OtherBC/BS - ENTERPRISE LOC
ALE51936Medicare UPIN
ALP00243744Medicare ID - Type UnspecifiedRAILROAD MEDICARE